Twitter communication of the UK public on dental health and care during a COVID lockdown: "My kingdom for a dentist".

BACKGROUND: The COVID-19 pandemic forced a UK-wide closure of dental services. An understanding of public concerns about dental care was urgently needed to inform careful resumption of paused dental services. AIM: To describe public concerns about dental care during lockdown. BASIC RESEARCH DESIGN: Framework analysis of relevant Twitter posts identified collected using the Awario tool. RESULTS: Of 1863 tweets manually screened for eligibility, 285 were relevant, as they contained views expressed by the public. The number of tweets by country were proportionate to the population size. The key views expressed in tweets focused on: 'oral health impact' ('oral health and self-care', 'types of dental problems', 'managing symptoms at home', 'views on consequences of delaying treatment') and 'dental service or care provision' ('views on managing dental care response', 'experiences with access to dental care'). CONCLUSIONS: The impact of COVID-19 on dental services raised many physical and mental health concerns for the public, highlighting their importance. Online profiles and social media communication platforms can be used to provide convenient, and timely information on public perceptions of dental care.

The Value of Preventative Dental Care: A Discrete-Choice Experiment.

Scale and polish (SP) and oral hygiene advice (OHA) are commonly provided in primary care dental practice to help prevent periodontal disease. These services are widely consumed by service users, incurring substantial cost, without any clear evidence of clinical benefit. This article aims to elicit general population preferences and willingness to pay (WTP) for preventative dental care services and outcomes. An online discrete-choice experiment (DCE) was completed by a nationally representative sample of the UK general population. Respondents each answered 10 choice tasks that varied in terms of service attributes (SP, OHA, and provider of care), outcomes (bleeding gums and aesthetics), and cost. Choice tasks were selected using a pivoted segmented experimental design to improve task realism. An error components panel logit model was used to analyze the data. Marginal WTP (mWTP) for each attribute and level was calculated. In total, 667 respondents completed the DCE. Respondents valued more frequent SP, care provided by a dentist, and personalized OHA. Respondents were willing to pay for dental packages that generated less frequent ("never" or "hardly ever") bleeding on brushing and teeth that look and feel at least "moderately clean." Respondents were willing to pay more (+£145/y) for improvements in an aesthetic outcome from "very unclean" (-£85/y) to "very clean" (+£60/y) than they were for reduced bleeding frequency (+£100/y) from "very often" (-£54/y) to "never" (+£36/y). The general population value routinely provided SP, even in the absence of reductions in bleeding on brushing. Dental care service providers must consider service user preferences, including preferences for both health and nonhealth outcomes, as a key factor in any service redesign. Furthermore, the results provide mWTP estimates that can be used in cost-benefit analysis of these dental care services.

Highly variable upper and abyssal overturning cells in the South Atlantic.

The Meridional Overturning Circulation (MOC) is a primary mechanism driving oceanic heat redistribution on Earth, thereby affecting Earth's climate and weather. However, the full-depth structure and variability of the MOC are still poorly understood, particularly in the South Atlantic. This study presents unique multiyear records of the oceanic volume transport of both the upper (<~3100 meters) and abyssal (>~3100 meters) overturning cells based on daily moored measurements in the South Atlantic at 34.5°S. The vertical structure of the time-mean flows is consistent with the limited historical observations. Both the upper and abyssal cells exhibit a high degree of variability relative to the temporal means at time scales, ranging from a few days to a few weeks. Observed variations in the abyssal flow appear to be largely independent of the flow in the overlying upper cell. No meaningful trends are detected in either cell.

How do we create, and improve, the evidence base?

Providing best clinical care involves using the best available evidence of effectiveness to inform treatment decisions. Producing this evidence begins with trials and continues through synthesis of their findings towards evidence incorporation within comprehensible, usable guidelines, for clinicians and patients at the point of care. However, there is enormous wastage in this evidence production process, with less than 50% of the published biomedical literature considered sufficient in conduct and reporting to be fit for purpose. Over the last 30 years, independent collaborative initiatives have evolved to optimise the evidence to improve patient care. These collaborations each recommend how to improve research quality in a small way at many different stages of the evidence production and distillation process. When we consider these minimal improvements at each stage from an 'aggregation of marginal gains' perspective, the accumulation of small enhancements aggregates, thereby greatly improving the final product of 'best available evidence'. The myriad of tools to reduce research quality leakage and evidence loss should be routinely used by all those with responsibility for ensuring that research benefits patients, that is, those who pay for research (funders), produce it (researchers), take part in it (patients/participants) and use it (clinicians, policy makers and service commissioners).

Practical considerations for conducting dental clinical trials in primary care.

There is increasing importance placed on conducting clinical trials in dentistry to provide a robust evidence base for the treatment provided, and models of care delivered. However, providing the evidence upon which to base such decisions is not straightforward, as the conduct of these trials is complex. Currently, only limited information is available about the strategies to deliver successful clinical trials in primary care settings, and even less available on dental clinical trials. Considerable knowledge and experience is lost once a trial is completed as details about effective management of a trial are generally not reported or disseminated to trial managers and researchers. This leads to loss of vital knowledge that could assist with the effective delivery of new trials. The aim of this study is to examine the conduct and delivery of five dental clinical trials across both Australia and the UK and identify the various factors that impacted upon their implementation. Findings suggest that early stakeholder engagement, and well-designed and managed trials, lead to improved outcomes for researchers, clinic staff and patients, and increases the potential for future dissemination and translation of information into practice.

The Audit Commission review of diabetes services in England and Wales, 1998-2001.

UNLABELLED: AIMS OF THE AUDIT COMMISSION: The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. METHODS: Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. RESULTS: Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. CONCLUSION: As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.

Setting priorities for research and development in the NHS: a case study on the interface between primary and secondary care.

Since 1991 the NHS has attempted to identify and prioritise its needs for research and development in a systematic manner. This has not been done before and there is little evidence on which to draw. Multidisciplinary expert groups have identified priorities in different topics using explicit criteria and after widespread consultation within the NHS and research community to identify pressing problems and opportunities for research. This paper focuses on a review completed in 1993 to identify research and development priorities for the NHS in relation to the interface between primary and secondary care. The review covered several recent developments which require evaluation. The authors describe the process used to identify research and development priorities in this complex subject and examine the strengths and weaknesses of the approach. This case study should help to stimulate a wider debate on methods of identifying priorities, particularly those using participatory approaches, in research and non-research contexts.

Clostridium difficile toxin A stimulates enzyme secretion from isolated rat pancreatic acini.

Although Cl difficile bacteremia and the presence of antibodies to toxin A (TxA) have been reported, little information is available at present on TxA effect on the functional properties of various visceral organs. We have, therefore, examined the in vitro effects of TxA on amylase and trypsin secretion from rat isolated pancreatic acini. Dispersed rat pancreatic acini were exposed for 60 min to different concentrations of highly purified TxA and the rate of amylase, trypsin and LDH release were monitored. Free cytosolic calcium release in pancreatic acini after toxin A (10(-10)M to 10(-8)M) treatment was measured with Fura-2/AM, Ca-indicator dye. TxA (10(-10) to 10(-8)M) increased significantly the rate of both the amylase and trypsin secretion without any membrane damage, with toxin A exerting its action via calcium dependent pathway as suggested by intracellular calcium release measured with Fura-2/AM.

Decontamination of instruments and control of cross infection in general practice.

OBJECTIVE: To assess the effectiveness of decontamination procedures in general practice. DESIGN: Anonymous postal questionnaire survey of 600 general practitioners randomly selected from the national register. SETTING: General practices throughout the United Kingdom. SUBJECTS: 382 General practitioners, a response rate of 65%. RESULTS: 186 General practitioners had autoclaves but 125 used hot water disinfectors or chemical disinfectants to reprocess instruments. 22% (474/2132) Of high risk instruments were inadequately decontaminated. Decontamination was performed by the practice nurse or receptionist in 306 practices. Knowledge of treatment of spillages of blood fluids was uncertain, and only 114 general practitioners used effective methods for dealing with spillages. CONCLUSIONS: A comprehensive central code of practice for control of infection is needed for primary health care staff.

Monocrotophos and dicrotophos residues in birds as a result of misuse of organophosphates in Matagorda County, Texas.

About 1100 birds of 12 species died from organophosphate poisoning in Matagorda County on the Texas Gulf Coast in March and May 1982. Birds died from feeding on rice seed that was illegally treated with dicrotophos or monocrotophos and placed near rice fields as bait to attract and kill birds. Brain acetylcholinesterase inhibition of affected birds averaged 87% (range 82-89%), and contents of gastrointestinal tracts contained residues of dicrotophos (5.6-14 ppm) or monocrotophos (2.1-13 ppm). Rice seed collected at mortality sites contained 210 ppm dicrotophos or 950 ppm monocrotophos. Mortality from dicrotophos poisoning continued for almost 3 weeks. The practice of illegally treating rice seed with either of these 2 organophosphates appears to be infrequent but widespread at present.

Pesticide, PCB, and lead residues and necropsy data for bald eagles from 32 states-1978-81.

In 1978-81, 293 bald eagles (Haliaeetus leucocephalus) from 32 states were necropsied and analyzed for organochlorine pesticides, polychlorinated biphenyls (PCB), and lead residues. DDE was found in all carcasses; PCB, DDD, trans-nonachlor, dieldrin and oxychlordane were next in order of percent frequency of detection. The median levels of DDE and PCB have declined when compared with previous collections. Five specimens contained high levels of dieldrin in their brains which may have contributed to their deaths. Seventeen eagles contained liver lead residues greater than 10 ppm and probably died of lead poisoning. Trauma and shooting are the most common causes of death.

Ultrastructural effects of Clostridium difficile toxin B on smooth muscle cells and fibroblasts.

The mechanism by which Clostridium difficile toxin B causes cells in culture to round was investigated. Cultured human lung fibroblasts and rabbit aortic smooth muscle cells were treated with partially purified or purified toxin B and monitored by light and transmission electron microscopy (TEM). Both preparations caused progressive cell rounding which correlated with disorganization of actin-containing myofilament bundles. Thin myofilaments became fragmented and finally disappeared (after 24 h) and dense bodies became more prominent, while all other organelles appeared unaffected.